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FORM 5500 DATA

J.R. Carlson Laboratories, Inc. 401k Plan and Turst

Overview

Plan Information

  • Plan Year01/01/2019 — 12/31/2019
  • Date of Plan01/01/1999
  • Net Assets as of 12/31/2019 $12,754,013
  • Plan Number2
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit Arrangement Trust

Participant Information as of 12/31/2019

  • Active (Eligible) Participants156
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits24
  • Subtotal180
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits1
  • Total181
  • Total number of participants as of 01/01/2019176
  • Number of participants with account balances173
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2

Expenses

  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • Address600 W. University Drive
  • CityArlington Heights
  • StateIL
  • Zip60004
  • Telephone(847) 255-1600
  • EIN36-2672870
  • Industry Code424210

Audit Information

  • Audit StatusAudited
  • AuditorWarady & Davis LLP
  • Auditor EIN36-2170602
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2A Age/Service Weighted or New Comparability or Similar Plan Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate allowed under the permitted disparity rules of section 401(l)
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G Total participant-directed account plan Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
2J Code section 401(k) feature A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
2K Code section 401(m) arrangement Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contributions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3D Master plan A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $1,000,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? No
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? No

Financials

Income and Expense Statement

Income $3,135,252
Contributions $1,114,525
Cash Contributions $1,114,525
Cash from Employers $254,949
Cash from Participants $716,816
Others (including rollovers) $142,760
Noncash Contributions $0
Total Earnings on Investments $2,020,727
Total Interest $19,207
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $4,948
Interest from Other Investments $14,259
Total Dividends $124,229
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $0
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $1,877,291
Other Income $0
Expenses $513,421
Total Benefit Payments $511,050
Directly to participants or beneficiaries, including direct rollovers $511,050
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $2,371
Professional Fees $0
Contract Administrator Fees $2,371
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $2,621,831
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2019 12/31/2018 Change YOY
Total Assets $12,754,013 $10,132,182 25.88%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $234,409 $354,337 -33.85%
Employer Contributions $208,360 $329,126 -36.69%
Participant Contributions $26,049 $25,211 3.32%
Other Contributions $0 $0 0.0%
General Investments $0 $0 0.0%
Interest-bearing cash $0 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $112,195 $34,962 220.91%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $0 $0 0.0%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $11,160,679 $8,402,305 32.83%
Value of funds held in insurance co. general account $1,246,730 $1,340,578 -7.00%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $12,754,013 $10,132,182 25.88%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

There is no information on eligible indirect compensation for this plan.

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Securities Service Network Inc Other services, Other commissions, Other fees Other Services $0 $45,528 $45,528
The Pension Specialists, Ltd. Contract Administrator, Other services, Direct payment from the plan, Other fees Other Services $585 $10,863 $11,448
Principal Life Insurance Company Contract Administrator, Participant loan processing, Direct payment from the plan, Recordkeeping fees Contract Administrator $1,786 $0 $1,786
Total $2,371 $56,391 $58,762

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
The Pension Specialists, Ltd. Principal Life Insurance Company Contract Administrator, Other services, Direct payment from the plan, Other fees Referral/Service Fee $10,863
Securites Service Network, Inc. Principal Life Insurance Company Other services, Other commissions, Other fees Commissions and Referral/Service Fee $45,528
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

No investments information available for this plan.

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Principal Life Insurance Company 170
EIN 42-0127290
Industry Code 61271
Contract Number 613953
Contract Year 01/01/2019 — 12/31/2019
Value in General Account at Year End $1,246,730
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $7,597
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Security Services Network Inc 9729 Cogdill Rd, Suite 301 Knoxville, TN 37932 -3383 Insurance Agent or Broker $6,171 $0
The Pension Specialists, Ltd. 10501 N. 2nd Street Machesney Park, IL 61115 Third Party Administrator $0 $1,426 REFERRAL/SERVICE FEE.
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract CUSTODIAL GUARANTEED INTEREST CONTRACT
Balance at the end of the previous year $1,340,578
Additions $152,231
Contributions Deposited during the year $77,270
Dividends and credits $0
Interest credited during the year $14,259
Transferred from separate account $0
Other $60,702
Total of Balance and Additions $1,492,809
Deductions $246,079
Disbursed from fund to pay benefits or purchase annuities during the year $72,644
Administration charge made by carrier $350
Transferred to Separate Account $0
Other $173,085
Balance at the end of the current year $1,246,730